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    Long-term surgical complications following pelvic exenteration: Operative management of the empty pelvis syndrome

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    Authors
    Sutton, Paul A
    Brown, K. G. M.
    Ebrahimi, N.
    Solomon, M. J.
    Austin, K. K. S.
    Lee, P. J.
    Affiliation
    Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
    Issue Date
    2022
    
    Metadata
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    Abstract
    Aim: Pelvic exenteration (PE) has become the standard of care for locally advanced and recurrent rectal cancer. The high short-term morbidity reported from this procedure is well established; however, longer term complications of such radical surgery and their management have not been fully addressed. This study aimed to investigate the incidence, indications and outcomes of long-term (more than 90-day) reoperative surgery in this group of patients, with a focus on the empty pelvis syndrome (EPS). Methods: Clinical data were extracted from a prospectively maintained database, with additional data pertaining to indications, operative details and outcomes of reoperative surgery obtained from electronic medical records. Patients were excluded if reoperative surgery was endoscopic or radiologically guided, was for the investigation or treatment of recurrent disease, or was clearly unrelated to previous surgery. Results: Of 716 patients who underwent PE, 75 (11%) required 101 reoperative abdominal or perineal procedures, 52 (51%) of which were in 40 (6%) patients for complications of EPS. This group were more likely to have undergone a total PE (65% vs. 43%; P < 0.01) with either major bony (70% vs. 50%; P < 0.01) and/or nerve (40% vs. 25%; P = 0.03) resections at index exenteration. The patho-anatomy, surgical management and outcomes of these patients are described herein, considering separately complications of entero-cutaneous fistula, entero-perineal fistula, small bowel obstruction and local management of perineal wound complications. Conclusion: Six per cent of PE patients will require re-intervention for the management of EPS. Reliable strategies for preventing EPS remain elusive; however, surgical management is feasible with acceptable short-term outcomes with the optimum strategy to be selected on an individual patient basis.
    Citation
    Sutton PA, Brown KGM, Ebrahimi N, Solomon MJ, Austin KKS, Lee PJ. Long-term surgical complications following pelvic exenteration: Operative management of the empty pelvis syndrome. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2022 Jun 29. PubMed PMID: 35766998. Epub 2022/06/30. eng.
    Journal
    Colorectal Disease
    URI
    http://hdl.handle.net/10541/625403
    DOI
    10.1111/codi.16238
    PubMed ID
    35766998
    Additional Links
    https://dx.doi.org/10.1111/codi.16238
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1111/codi.16238
    Scopus Count
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